Out of all the cancers that affect humans, oral malignancies are one of the worst as they affect form, function, and esthetics. The age-adjusted rates of oral cancer in India is 20/10,000 population and accounts for 10% of all cancers in the country. To set a perspective of where we stand today globally, India alone accounts for a third of all oral cancer cases and little less than half of all oral cancer deaths. With a 16% projected increase in oral cancer cases in the next 5 years, effective preventive strategies remain an urgent public health priority in India.

Tobacco use, in all forms, remains the major risk factors causing almost 90% (with excessive alcohol use) of the oral cancers. India is the second largest consumer of tobacco. The GATS-2 reports have shown that 28.6% of the population consumes tobacco in some form, with 10.7% smoking and 21.4% using smokeless forms. Khaini (smokeless) and beedi (smoked) are dominant forms of tobacco consumed in India at 11% and 8%, respectively. What is overwhelming is a third of the users are in the most productive age group, making them highly susceptible to these cancers. This trajectory not only implies a high cost but also places a heavy burden to the economy. With the current tobacco control interventions in place, we have seen a 17% decrease in the number of tobacco users from 2009 to 2010. The reduction in tobacco consumption requires intensifying efforts to prevent initiation of use and promote cessation among the large proportion of youth who are currently consumers.

The challenges to tackle oral cancer in India are multifold. Most of the cases are diagnosed at advanced stages that result in poor outcomes even after receiving appropriate treatment. The rural areas have inadequate access to trained health-care providers and services, which results in delay in diagnosis and treatment. In fact, oral cancer has been seen to affect the lower socioeconomic strata due to higher exposure to risk factors. Early detection of the disease can offer the best chance for long-term survival and could potentially improve outcomes, making treatments affordable.

A comprehensive approach is needed to curb this disease and should include health education and literacy, risk factor reduction, and early diagnosis. Efforts need to be made in organized awareness programs to educate society and eliminate the social stigma of diagnosis. Simply preventing the usage of these substances and improving the quality of dietary intake can prevent a large majority of cases. Identification of premalignant and precursor lesions is important as they may regress if tobacco use ceases. Despite the fact that the oral cavity is easily accessible for visual examination, oral cancers are typically detected in their advanced stages. In India, 60%–80% of patients present to health-care workers with advanced disease as compared to 40% in developed countries. It is imperative that cost-effective oral cancer screening and awareness initiatives be introduced in high-risk populations in India. Many large population-based oral cancer screening programs have been carried out that have confirmed the effectiveness of screening to detect oral cancer and precancerous lesions. Early detection of the disease is equally important, as they are potentially curable in early stages with relatively inexpensive treatments.

Although oral cancer can be prevented, controlled, and treated, there exists a significant gap in the Indian population's knowledge, attitudes, and behavior. Efforts must be made to introduce a suite of preventive measures that can significantly reduce the burden and to help bridge the gap between research and awareness. Dissemination of knowledge to help individuals adopt better behavior patterns to improve their health and promote lifestyle modifications is a key to confronting this challenge.

Disclosure

This material has never been published and is not currently under evaluation in any other peer reviewed publication.

Ethical approval

The permission was taken from Institutional Ethics Committee prior to starting the project. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.